By Andrew C. Trecartin ’11
At midnight the phone rang. “A woman who just gave birth is bleeding a lot.” In the operating room Staci L. Davenport ’14 was performing a curettage to make sure no pieces of placenta were causing the problem. Medications oxytocin and methergine were in. Staci had also verified there were no major lacerations in the birth canal. We then quickly packed the uterus with gauze in an attempt to stop the hemorrhage. This woman had been laboring for days at home after her water broke. Her inflamed uterus was not clamping down like it should have. Phillipe, our nurse who performs anesthesia, was infusing another bag of blood.
Something drew my attention. It was the pulse on the oxygen sensor. Her heart rate was 170 beats per minute. My heart sank. Was that real? The last blood pressure (BP) reading was 80/50. Was that heart rate reading true? It was ominous. The BP cuff finished cycling: 60/30. Her life at its end flashed before my eyes. Within minutes she would be dead.
The blood was already pouring out in spite of the gauze packing. I asked Phillipe to run two bags of blood at the same time. “We’re doing a hysterectomy,” I said, as I opened the kit. I threw betadine on her abdomen and started in with the scalpel blade. Her blood pressure was not measurable now. Quick, clamp cut tie, clamp cut tie. “Please give more blood. Yes, more blood!” Phillipe ran to the refrigerator again. The woman’s blood pressure intermittently read at 50/30 when the machine would pick it up. Final clamp, cut, uterus out. Breathe. The bleeding stopped. The transfusion total was nine units of blood.
Her husband was more educated than many of our patients. His anxious face relaxed in relief with the news. He understood we had to take out the uterus and said, “Whatever it took to save her, thank you.”
Walking back to our house in the dark morning hours, a flood of emotion overtook me. Her life, falling precipitously, was caught just in time. She is alive. People like Olen ’07 and Danae Netteburg ’06, by their sweat and tears, have developed the only blood bank in this part of the country. People hate donating blood here because it diminishes their “force” to work in the fields. However, every elective surgery patient must have a family member donate a unit of blood. We explain that if the patient needs it during surgery then we give it. If it is not, we use it for emergencies.
Consequently, every hernia we’ve worked hard to repair was another life-saving unit of blood. The generators, fuel, and the mechanic to maintain electricity (most of the time) is beyond what the majority of hospitals in Chad can afford. We have the luxury of keeping our blood bank refrigerator running.
Our transfusion protocol includes a built-in 1:1:1 ratio of red blood cells, platelets, and plasma. Even many rural trauma centers in the United States have not yet achieved ideal ratios of plasma to packed red blood cells. All we have is whole blood and that is what we give. Sadly, we have lost women to postpartum hemorrhage, most often the ones with uncommon blood types.
This woman will raise her kids. People are not surprised when a mother dies in childbirth here. This “never event” in the States is pervasive here in Chad. Many children grow up without the mothers they lost in childbirth. Not for this family though. She is alive!